Provider Demographics
NPI:1003180159
Name:CONCENTRA HEALTH SERVICES INC
Entity Type:Organization
Organization Name:CONCENTRA HEALTH SERVICES INC
Other - Org Name:CONCENTRA MEDICAL COMPLIANCE ADMINISTRATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:TOM
Authorized Official - Last Name:FOGARTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-364-8000
Mailing Address - Street 1:PO BOX 9008
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-9008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8850 FM 2658 N
Practice Address - Street 2:
Practice Address - City:TATUM
Practice Address - State:TX
Practice Address - Zip Code:75691-3401
Practice Address - Country:US
Practice Address - Phone:855-289-6757
Practice Address - Fax:800-310-5984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-06
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile